Combining hospice, med/surg helps hospitals

Hospitals with specialized units combining the compassionate care of hospice and the level of care offered in medical-surgical units may provide efficient, cost-effective assistance to patients with advanced chronic illness or terminal disease, according to a study.

“Acute Palliative Care Units, APCUs, are really a new frontier in managing patients with end-stage chronic disease,” study co-author Marlene McHugh, DNP, FNP, assistant professor of clinical nursing at Columbia University School of Nursing and associate director of palliative care at Montefiore Medical Center in New York City, said in a news release.

“In an APCU, patients receive acute and palliative care regardless of prognosis, the technology required to keep a patient alive or end-of-life wishes. In addition, these units are primarily managed by palliative medicine specialists, working with medical management.”

McHugh is one of the first nurse practitioners in New York City to move palliative care into the acute care hospital setting, according to the news release. Establishing APCUs allows patients to leave the ICU yet still receive a high level of medical care focusing on patients’ values and treatment preferences, and support for their family members.

Potential cost benefits can be achieved by managing terminally ill patients in APCUs rather than in ICUs or med/surg, according to the study, and these benefits are more likely to occur when patients are directly managed by palliative care specialists, trained in chronic disease management and family and end-of-life counseling. This combination of advanced disease management and personal counseling can assist patients and families in the transition from aggressive treatment to more palliative care, the researchers wrote, with recent studies indicating palliative care counseling can shorten ICU stays, reduce costs and enhance the overall quality of care.

For the study, which spanned 2007-2010, researchers looked at the admissions and economic implications in ICUs, med/surg units and ACPUs, with special focus on Montefiore Medical Center’s APCU.

The study, scheduled for publication in the American Journal of Hospice & Palliative Medicine, examined several factors at Montefiore: demographics, diagnosis-related groups, length of hospital stays, discharge status and hospital charge data. The research indicated that a high proportion of patients were admitted to the APCU from critical care units, suggesting a pronounced need for such units to service patients when hospital-based end-of-life care is needed.

Notably, the researchers said, the use of ICUs during the last month of life for Medicare beneficiaries with cancer was dramatically lower (12.1%) at the Montefiore APCU compared with 137 other academic medical centers in the United States. The creation of the APCU resulted in statistically significant reductions in both the ICU mortality rate and the length of stay as terminally ill patients were transitioned out of the ICU.

“We are creating the future by bringing palliative care units within hospital walls,” study co-author Serife Eti, MD, director of the Fellowship Program in Palliative Medicine at Beth Israel Medical Center’s Department of Pain Medicine and Palliative Care, said in the news release.